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The promises and pitfalls of reboxetine
Journal article   Open access

The promises and pitfalls of reboxetine

Michelle E Page
CNS drug reviews, v 9(4), pp 327-342
Dec 2003
DOI: https://doi.org/10.1111/j.1527-3458.2003.tb00258.x
PMID: 14647527
url
https://www.ncbi.nlm.nih.gov/pmc/articles/6741698View
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Abstract

Animals Antidepressive Agents - adverse effects Antidepressive Agents - pharmacology Antidepressive Agents - therapeutic use Brain - drug effects Clinical Trials as Topic Depressive Disorder - drug therapy Humans Mice Microdialysis Morpholines - adverse effects Morpholines - pharmacology Morpholines - therapeutic use Norepinephrine - metabolism Physical Exertion - drug effects Swimming Treatment Outcome
The antidepressant compound, morpholine, 2-[(2-ethoxyphenoxy)phenylmethyl]-,methanesulfonate, or reboxetine, is a selective noradrenergic reuptake inhibitor that acts by binding to the norepinephrine (NE) transporter and blocking reuptake of extracellular NE back into terminals. This compound has low affinity for other transporters and receptors. The development of reboxetine as a potential antidepressant stems from the prior demonstration that blockade of the NE transporter imparts antidepressant activity. Desipramine, lofepramine, and nortryptiline are examples of tricyclic antidepressant (TCA) compounds from the first generation of antidepressants that exert their effects by blockade of NE reuptake. Maprotiline, a non-tricyclic compound, is also a NE selective reuptake inhibitor. Unfortunately, these antidepressants are also associated with interactions with muscarinic, histaminergic, and adrenergic receptors, which are known to contribute to a variety of untoward side effects. Despite the positive pharmacological profile of reboxetine, i.e., selectivity and specificity, with relatively fewer side effects, its use as an antidepressant is currently limited to Europe. Reboxetine is marketed as Edronax in the UK, Norebox in Italy, and as Irenor in Spain. It is registered in Germany, Sweden, Denmark, Ireland, Austria and Finland. Based on studies conducted primarily outside the US, the FDA granted a preliminary letter of approval in 1999. However, more recent clinical studies conducted in the US and Canada, prompted by the FDA, resulted in a letter of non-approval. To date, it is unclear why the further development of reboxetine as an antidepressant in the US has been halted. Despite this setback, reboxetine has been a valuable pharmacological tool to assess the role of the noradrenergic system in preclinical studies of depressive disorder.

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